Multidisciplinary Concussion Management: A Model for Outpatient Concussion Management in the Acute and Post-Acute Settings

Abstract

Objective: To describe a model of multidisciplinary concussion management and explore management methods in the acute and post-acute settings. Setting: A multidisciplinary concussion management program within a large health system. Participants: Patients with sports and non–sports-related concussions aged 14 to 18 years with persisting concussion symptoms at 4 weeks postinjury or beyond. Design: Pilot randomized controlled trial comparing a subsymptom threshold exercise program with standard-of-care treatment in the post-acute setting. Main Measures: Beck Depression Inventory-II and the Post-Concussion Scale-Revised. Results: Across groups, 60% improvement in concussion symptoms was noted. After removing the influence of depression, the intervention showed a large effect on symptom reduction, with participants in the intervention group improving more than those in the control group. There was no difference in response to the intervention by the sports and nonsports groups. Conclusion: Results demonstrate that exercise intervention is effective in reducing symptoms in adolescents with persisting symptoms. The finding that participants in the control group who underwent education, light activity, and sophisticated monitoring still had meaningful recovery supports the utility of active engagement in a multidisciplinary management program. Finally, depression had a clinically meaningful effect on recovery, highlighting the need for targeted intervention of noninjury factors relevant to persisting symptoms.

Acute and chronic management of posttraumatic headache in children: A systematic review

“…We identified six studies (three prospective, [38][39][40] three retrospective [41][42][43] ) that evaluated PT and timing of increased activity on PTH in youth. Some reported headache improvement, whereas others found modest or no effect.…”

“…There was a significant effect in the intervention group when total postconcussion symptoms scores were evaluated, but significance testing comparing headache outcomes in the two groups was NR. 39 A prospective study found that completing diagnostic exertional testing did not significantly reduce headache symptom scores 24 h after testing. This study was limited by a high drop-out rate (31%).…”

“…Of 27 studies, 7 reported headache with migrainous features, 6,17,21,29,34,35,46 7 reported on premorbid migraine history, 6,22,24,25,35,39,42 and 3 reported on migraine family history. 6,24,34 When reported, the frequency of headache was high, with 61%-87% of patients described as having daily or constant headache.…”

Understanding Cognitive Communication Needs in Pediatric Traumatic Brain Injury: Issues Identified at the 2020 International Cognitive-Communication Disorders Conference

“…Such an interdisciplinary approach allows for the whole to be more than the sum of its parts and for intervention to be harmonized across disciplines to the benefit of the client. Although "speech therapy" is identified in some instances as a specialty to be involved with people who have cognitive complaints after concussion (Bazarian, 2019;Hardin & Kelly, 2019), a description of CCDs and involvement of SLPs is not offered in many publications describing either multidisciplinary or interdisciplinary models (e.g., Bailey et al, 2019;Scratch et al, 2019). Furthermore, even though many SLPs are aware of CCDs, most assessments used by interdisciplinary partners in TBI care, including concussion, do not include tools or items that would highlight CCDs that would then easily lead to referral for SLP services.…”

Séquelles cognitives, physiques et psychopathologiques à long terme de multiples commotions cérébrales : illustration par l’évaluation et la prise en charge d’un hockeyeur semi-professionnel

“…Ce système de gestion des symptômes et de choix d'activités a été couplé au concept clé « maximiser ce qui fait du bien et minimiser ce qui fait du mal » (Beni, 2019). La marche extérieure a été imposée à FB, comme activité quotidienne, car les bienfaits d'une activité à faible intensité sur le processus de récupération sont aujourd'hui largement reconnus (Bailey et al, 2019). La marche est donc imposée à tout sportif qui consulte à la suite d'une CC.…”